This application addresses broad Challenge Area (05): Comparative Effectiveness Research and Specific Challenge topic 05-LM-104* Value of "Virtual Reality" Interaction in Improving Compliance with Diabetic Regimen. Diabetes has become a serious public health problem. According to data from the American Diabetes Association, 21 million Americans have diabetes, and 95% of those cases are Type 2 (ADA Standards of Medical Care in Diabetes, 2008). The Look AHEAD Program (Look AHEAD, 2007) is one intervention that has proven efficacious in reducing weight, increasing physical activity, and improving metabolic factors in adults with type-2 diabetes. However, the Look AHEAD Program has not yet been effectively translated into care. The major barrier to translation for programs like Look AHEAD is the extended clinical contact required for these interventions to be efficacious. Intensive interventions often are not feasible within primary care due to lack of time and constraints on office systems, and other health-promotion programs (e.g., employee wellness) often do not adopt such programs because of their up-front costs. Thus, there is a clear challenge to create new methods for delivering effective interventions to the population of patients and employees with diabetes who are at high risk for cardiovascular disease and death. The proposed research seeks to translate the Look AHEAD (LA) intensive lifestyle intervention into employee health programs through the development of a Virtual Look AHEAD Program (VLAP). The VLAP will (1) interact with the diabetic patient to create a preliminary treatment plan that is then approved in a visit with their study practitioner, (2) provide ongoing LA-based nutrition and physical activity counseling that is available on demand, 24/7 from any Internet-connected computer and browser-capable mobile device, and (3) collect data on patient adherence, health, and motivation. Because the VLAP will be developed to be available through Internet devices, customized treatment plans will be monitored for effectiveness and safety in a monthly office visit with the study employee health care practitioner (e.g., nutritionist, nurse, nurse practitioner, or physician assistant). The proposed pilot study will test the initial use of the VLAP in a small randomized comparative effectiveness pilot in employees recruited from two large self-insured employers in Rochester, New York comparing Group 1 VLAP + study practitioner (N=35) vs. Group 2 Standard Diabetes Support and Education + study practitioner (N=35) in reducing weight to LA goal of 7% loss over 6 months. This project will create an electronic physical activity counselor, and nutritionist that will discuss healthy behaviors (physical activity, nutrition) with employees with diabetes and help employees build a plan for weight loss and increased physical activity to reduce their risk for heart disease.